Provider Demographics
NPI:1679773394
Name:HARMON, JENNIFER JOY (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:JOY
Last Name:HARMON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:711 STANTON L YOUNG BLVD
Mailing Address - Street 2:215
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5023
Mailing Address - Country:US
Mailing Address - Phone:405-271-4113
Mailing Address - Fax:405-271-5723
Practice Address - Street 1:711 STANTON L YOUNG BLVD
Practice Address - Street 2:215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5023
Practice Address - Country:US
Practice Address - Phone:405-271-4113
Practice Address - Fax:405-271-5723
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102715363AS0400X
OK1720363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical